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HOME > What we do > HIRA's Role and Function > Rule Making

Rule Making

  • Medical treatment management procedure
  •  ·  The healthcare provider applies for NHI coverage of treatment which has obtained safety and efficacy approval.
  •     HIRA assesses its replaceability and cost-effectiveness to determine whether to include the service into the benefit
  •     package, and decide the reimbursement price of the service
  •  ·  In order to review the target and range of reimbursement, HIRA researches national and international clinical
  •     studies, literature, basic data, and opinions of professionals Standards for reimbursement (for example how many
  •     times it will be covered under NHI) are determined in consideration of service necessity, clinical effectiveness,
  •     cost-effectiveness, etc.
  •  ·  The relative value scale is revised when there are changes in the components of relative value.

  • Operational Performance
  •  ·  Data used as the basis material for medical fee payment unit, healthcare statistics and health studies
  •  ·  Saved national healthcare expenditure by selecting covered services and setting prices in consideration of economic
  •     condition
  •  ·  Unified standard codes make it easier to calculate statistics for disease prediction and public health services across
  •     the nation
  •  ·  Enhanced understanding and acceptability of the program through the coordinating efforts with stakeholders in the
  •     healthcare industry
  •  ·  Operation of national standard treatment code
  •  ·  Ensure the procedure of introducing new medical technologies
  •  ·  Facilitate links between computer systems via a standardized code